VA doctors consult long-distance experts by video

The Veterans Affairs Medical Center in Grand Junction will now have some extra help in its intensive care unit, but not in the form of new staff.

The hospital officially joined the VA's Tele-Intensive Care Unit system, which brings intensivist doctors into each ICU room over video screens who can di agnose and help treat patients.

The Grand Junction VA hospital officially joined the system May 30 and is the 17th facility in the program.

"This really allows us to increase the complexity of patients that we see here while bringing in a second set of eyes on our staff," Grand Junction VA Director Michael Kilmer said.

The Tele-ICU system started at the VA in 2011 in Minneapolis and has expanded since that time. The goal is to bring critical care to participating facilities by providing access to intensivists and nurses around the clock.

The benefit is to add expertise to the hospital without the cost of hiring multiple intensivists — who specifically provide care for critically ill patients — while leaning on doctors with more general knowledge to provide bedside care.

"It basically doubles the staff," said Matthew Goede, associate medical director of Tele-ICU for the Midwest. "It helps cover that specialty service where the patients need it."

The Tele-ICU center is based in Minneapolis, with nurses and doctors staffing the center at all times of the day. Doctors can also be based in Chicago or Iowa City. Each ICU room at the VA is equipped with a TV screen, camera and a green button that can let doctors and nurses know their assistance is needed.

Dr. Krishnan Sriram, a VA intensivist in Chicago, said he can evaluate a patient's color, see their charts, check X-rays and zoom in on any detail in the room. He noted when he is not actively helping a patient or doctor, the camera is disabled.

Typically there is some sort of audible noise when the camera is activated to let the patient know that someone is now virtually visiting the room.

Sriram said the intensivists are still dependent on the doctors and nurses who are physically in the room with the patient. Oftentimes, he said, those doctors' instincts are still correct, but it is useful to get another expert opinion.

"We are dependent on the physical exam," Sriram said. "We can never replace a bedside evaluation."

Doctors in the room are typically hospitalists and have more general knowledge. Often, they have less experience dealing with the critically ill patients who would be in the ICU.

"The great thing about Tele-ICU is whatever we see here, they see 1,000 times per day," Grand Junction VA Chief of Staff Dr. Srinivas Ginjupalli said.

The Grand Junction VA is the second in the Rocky Mountain region and the first in Colorado to join the Tele-ICU system. Each of its five ICU rooms is now fully equipped with Tele-ICU technology.

Kilmer believes the program is great for rural facilities — about 55 percent of patients in the 17 Tele-ICU facilities are rural — as it allows them to be cost effective and serve more patients.

This is not the first telehealth service the hospital has been involved with, but it is the first that deals with patients who are admitted to the hospital.

"Being a small rural facility, it's a good opportunity for us to bring in support that we couldn't otherwise afford," Kilmer said. "Now we have 24/7 coverage every day of the year when we wouldn't be able to do that locally."

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